Individual
MISS EN SORM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1803 W MARCH LN STE AC&D, STOCKTON, CA 95207-6458
(209) 636-5353
(209) 636-5356
Mailing address
1803 W MARCH LN STE AC&D, STOCKTON, CA 95207-6458
(209) 636-5353
(209) 636-5356
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT28784
CA
374700000X
Technician
PT28784
CA
Other
Enumeration date
08/29/2006
Last updated
08/21/2023
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